scholarly journals Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 537-537
Author(s):  
Emily Franzosa ◽  
Abraham Brody ◽  
Bruce Leff ◽  
Christine Ritchie ◽  
Bruce Kinosian ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Nurse Managers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Provider Perceptions ◽  
Home Based Primary Care ◽  
Sensitive Topics ◽  
Home Based

Abstract The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nurse practitioners, nurse managers, and social workers at 6 NYC practices (N=13) in spring 2020. We used combined open and focused coding to identify themes. Participants employed both hospital-supported and commercial technological platforms to maintain care during COVID-19. Benefits of video telehealth included improved efficiency, capacity and collaboration between providers. Barriers included patients’ physical, cognitive or technological abilities, dependence on caregivers and aides to facilitate video visits, challenges establishing trust with new patients and addressing sensitive topics over video, and concerns over missing important patient information. Considering patient, clinical, and technological conditions can help optimize telehealth implementation among older homebound adults.

scholarly journals The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 383-383
Author(s):  
Emily Franzosa ◽  
Sybil Masse ◽  
Abraham Brody ◽  
Jonathan Ripp ◽  
Katherine Ornstein ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
Psychological Impact ◽  
Well Being ◽  
Primary Care Providers ◽  
Personal Accomplishment ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based

Abstract Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.

scholarly journals “There Is Something Very Personal About Seeing Someone’s Face”: Provider Perceptions of Video Visits in Home-Based Primary Care During COVID-19

2021 ◽  
pp. 073346482110283
Author(s):  
Emily Franzosa ◽  
Ksenia Gorbenko ◽  
Abraham A. Brody ◽  
Bruce Leff ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
Nurse Managers ◽  
Adult Population ◽  
Provider Perceptions ◽  
Home Based Primary Care ◽  
Home Based ◽  
Rapid Deployment ◽  
Older Adult Population

The rapid deployment of video visits during COVID-19 may have posed unique challenges for home-based primary care (HBPC) practices due to their hands-on model of care and older adult population. This qualitative study examined provider perceptions of video visits during the first wave of the COVID-19 crisis in New York City (NYC) through interviews with HBPC clinical/medical directors, program managers, nurse practitioners/nurse managers, and social work managers ( n = 13) at six NYC-area practices. Providers reported a combination of commercial (health system-supported) and consumer (e.g., FaceTime) technological platforms was essential. Video visit benefits included triaging patient needs, collecting patient information, and increasing scheduling capacity. Barriers included cognitive and sensory abilities, technology access, reliance on caregivers and aides, addressing sensitive topics, and incomplete exams. Effectively integrating video visits requires considering how technology can be proactively integrated into practice. A policy that promotes platform flexibility will be crucial in fostering video integration.

scholarly journals Who Provides Care in a Crisis? Family Caregivers’ Experiences of Home Care During the COVID-19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 537-537
Author(s):  
Sasha Perez ◽  
Katherine Ornstein ◽  
Jennifer Reckrey
Keyword(s):  
Primary Care ◽  
Home Care ◽  
Family Caregivers ◽  
Primary Care Providers ◽  
Direct Care ◽  
Care Providers ◽  
Structured Interviews ◽  
Home Based Primary Care ◽  
Home Based ◽  
Paid Caregivers

Abstract Many homebound individuals with dementia rely on both paid caregivers (e.g., home health aides, home attendants, other homecare workers) and family caregivers to live safely at home. We conducted semi-structured interviews with 15 family caregivers of individuals with severe dementia receiving home-based primary care in NYC to explore how caregiving changed during the COVID pandemic. Most individuals with long-standing paid caregivers experienced infrequent home care disruptions. In fact, paid caregivers were often the primary and sometimes only individuals to provide direct care; family caregivers themselves often stayed away and managed care from a distance. While most family caregivers described heightened attention to infection control, guidance about COVID prevention and safety rarely came from home-based primary care providers or home care agencies and instead was considered “common sense.” These findings confirm the essential role paid caregivers play in home-based dementia care teams.

“I felt useless”: a qualitative examination of COVID-19’s impact on home-based primary care providers in New York

2021 ◽  
pp. 1-15
Author(s):  
Ksenia Gorbenko ◽  
Emily Franzosa ◽  
Sybil Masse ◽  
Abraham A Brody ◽  
Orla Sheehan ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Primary Care Providers ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals Stressors Facing Home-Based Primary Care Providers

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Katherine O’Brien ◽  
Sara Bradley ◽  
Vanessa Ramirez-Zohfeld ◽  
Lee Lindquist
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Cross Sectional ◽  
Home Setting ◽  
Caregiver Support ◽  
Qualitative Survey ◽  
Home Based Primary Care ◽  
Home Based

The numbers of homebound patients in the United States are increasing. Home-based primary care (HBPC) is an effective model of interdisciplinary care that has been shown to have high patient satisfaction rates and excellent clinical outcomes. However, there are few clinicians that practice HBPC and clinicians that do face additional stressors. This study sought to better understand the stressors that HBPC providers face in caring for homebound patients. This was a cross-sectional qualitative survey and analysis of HBPC providers. Responses were categorized into four themes: The patient in the home setting, caregiver support, logistics, and administrative concerns. This research is the first to analyze the stressors that providers of HBPC face in serving the needs of complex homebound patients. Awareness and attention to these issues will be important for the future sustainability of home-based primary care.

Nurse Practitioner Home-Based Primary Care: A Model for the Care of Frail Elders

2008 ◽  
Vol 1 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Patricia Auer ◽  
Anita Nirenberg
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Doctor Of Nursing Practice ◽  
Frail Elders ◽  
Home Based Primary Care ◽  
Home Based ◽  
The Cost

Growing numbers of frail older adults find it increasingly difficult to leave their homes in order to access health care. Primary care providers in the home-based setting must have expertise in chronic illness management, illness and injury prevention, and quality-of-life care. The doctor of nursing practice brings specific competencies and nursing background to the role of primary care provider and is therefore the ideal health professional to provide primary care to frail elders in this setting. Further research is needed to determine the cost-effectiveness of home-based primary care and its effect on caregiver stress.

Perceived Effectiveness of Home-Based Primary Care Teams in Veterans Health Administration

2019 ◽  
Vol 60 (3) ◽  
pp. 494-502 ◽  
Author(s):  
Helena Temkin-Greener ◽  
Jill Szydlowski ◽  
Orna Intrator ◽  
Tobie Olsan ◽  
Jurgis Karuza ◽  
...  
Keyword(s):  
Primary Care ◽  
Team Effectiveness ◽  
Primary Care Providers ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Data Set ◽  
Indirect Measure ◽  
Home Based Primary Care ◽  
Home Based

Abstract Background and Objectives Previous studies have shown that staff perception of team effectiveness is related to better health outcomes in various care settings. This study focused on the Veterans Health Administration’s Home-Based Primary Care (HBPC) program. We examined variations in HBPC interdisciplinary teamwork (IDT) and identified modifiable team and program characteristics that may influence staff perceptions of team effectiveness. Research Design We used a broadly validated survey instrument to measure perceived team effectiveness, workplace conditions/resources, group culture, and respondents’ characteristics. Surveys were initiated in January and completed in July, 2016. Methods Team membership rosters (n = 249) included 2,852 IDT members. The final analytical data set included 1,403 surveys (49%) from 221 (89%) teams. A generalized estimating equation model with logit link function, weighted by survey response rates, was used to examine factors associated with perceived team effectiveness. Results Respondents who served as primary care providers (PCPs) were 8% more likely (p = .0044) to view team’s performance as highly effective compared to other team members. Teams with nurse practitioners serving as team leader reported 6% higher likelihood of high-perceived team effectiveness (p = .0234). High team effectiveness was 13% more likely in sites where the predominant culture was characterized as group/developmental, and 7%–8% more likely in sites with lower environmental stress and better resources and staffing, respectively. Conclusions and Implications Team effectiveness is an important indirect measure of HBPC teams’ function. HBPC teams should examine their predominant culture, workplace stress, resources and staffing, and PCP leadership model as part of their quality improvement efforts.

Staff Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: A Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Andrzej Kozikowski ◽  
Jillian Shotwell ◽  
Eve Wool ◽  
Jill Slaboda ◽  
Gregory Norman ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Qualitative Study ◽  
Nurse Practitioners ◽  
Care Program ◽  
Work Climate ◽  
Structured Interviews ◽  
Medical Needs ◽  
Home Based Primary Care ◽  
Home Based

BACKGROUND Novel and sustainable approaches to scale Home-Based Primary Care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the US. Telehealth may be a viable option for scaling HBPC programs. OBJECTIVE The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to scale the program. METHODS We collected qualitative data from HBPC staff (physicians, nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York Metropolitan area through 16 semi-structured interviews and 3 focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (relatedness, competence, and autonomy) as an analytical lens. RESULTS Four broad themes (work climate, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship) and multiple second-level themes emerged from the analysis. Within the theme of work climate, staff acknowledged the need to scale the program without diminishing effective patient-centered care. Within the theme of technology impact on staff autonomy, participants perceived alerts generated from patients and caregivers using telehealth as a potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. Regarding technology impact on competence in providing care, participants noted that it could increase efficiency and enable more informed care provision. Regarding technology impact on the patient-provider relationship, participants noted the opportunity to make caregivers part of the team through telehealth. Staff members, however, were concerned that patients or caregivers might unnecessarily over utilize the technology, and that some visits are more appropriate in-person rather than via telehealth. CONCLUSIONS These findings suggest the importance of taking into account the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program is likely to facilitate the integration of telehealth innovations. CLINICALTRIAL Not applicable

Prescriber Acceptance of Pharmacist-Written Recommendations in a Home-Based Primary Care Setting at a Veterans Affairs Healthcare System

2021 ◽  
Vol 36 (1) ◽  
pp. 56-62
Author(s):  
Micaela M. Leblanc ◽  
Kim Daley ◽  
Karen Pickel ◽  
Lauren Zaets
Keyword(s):  
Primary Care ◽  
Healthcare System ◽  
Primary Care Providers ◽  
Acceptance Rate ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Acceptance Rates ◽  
Larger Sample

OBJECTIVE: To assess prescriber acceptance of pharmacist-written recommendations and to identify areas of improvement for implementing and tracking pharmacist-written reviews.DESIGN: Phase one was a retrospective study to evaluate prescriber acceptance of pharmacist-written recommendations. Phase two consisted of the distribution of a brief anonymous survey for prescribers to provide input on preferences for pharmacist-written recommendations.SETTING: Patients receiving Home-Based Primary Care (HBPC) services at VA Connecticut Healthcare System. PARTICIPANTS: Fifty veterans admitted to the HBPC program from January 2019 to April 2019 with at least 3 months of follow-up per patient.MAIN OUTCOME MEASURE: The primary outcome was the prescriber acceptance rate of HBPC pharmacistwritten recommendations.RESULTS: Out of 194 total pharmacist-written recommendations documented, 40.2% were accepted by providers. Specialty providers accepted a higher percentage of recommendations than primary care providers. Recommendations had a higher acceptance rate when both an attending provider and trainee were alerted (63.0%) versus an attending alone (36.1%). The anonymous survey concluded the majority of providers appreciate short, direct, clinically relevant summary recommendations.CONCLUSION: Overall, approximately 40% of the pharmacist-written recommendations were accepted and 66.7% were appropriately tracked, demonstrating there are opportunities for improvement. Formulating short, focused, and direct recommendations as well as ensuring to alert both attendings and trainees when indicated may optimize acceptance rates. Further research with a larger sample size is still needed to assess the barriers to prescriber acceptance of pharmacist-written recommendations.

scholarly journals How do physicians and nurses in family practice describe their care for patients with progressive life-limiting illness? A qualitative study of a ‘palliative approach’

2019 ◽  
Vol 20 ◽  
Author(s):  
Alex Rewegan ◽  
Sharef Danho ◽  
Joy White ◽  
Samantha Winemaker ◽  
Nicolle Hansen ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Functional Decline ◽  
Primary Care Providers ◽  
Care Providers ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Team Members ◽  
Palliative Approach ◽  
Primary Care Clinicians

Abstract Aim: To explore how a palliative approach to care is operationalized in primary care, through the description of clinical practices used by primary care clinicians to identify and care for patients with progressive life-limiting illness (PLLI). Background: Increasing numbers of people are living with PLLI but are often not recognized as needing a palliative approach to care. To meet growing needs, generalists such as family physicians will need to adopt a palliative approach to care in their own setting. Practical descriptions of a palliative approach in non-specialist settings have been lacking. Methods: We conducted a qualitative descriptive study design using in-depth semi-structured interviews with 11 key informant participants (6 physicians, 3 nurse practitioners, 1 registered nurse, and 1 registered practical nurse) known to be providing comprehensive care to patients with PLLI in family practices in Ontario, Canada. We asked about their approach to identifying patients with PLLI and the strategies used in their care. We employed content analysis to develop themes. Findings: Participants identified patients by functional decline, change in needs, increased acuity, and the specifics of a condition/diagnosis. Care strategies included concretizing commitment to care, eliciting goals of care, shifting care to the home, broadening team members including leveraging the support of family and community resources, and shifting to a ‘proactive’ approach involving increased follow-up, flexibility, and intensity. Conclusion: Primary care providers articulated strategies for identifying and providing care to patients with PLLI that illuminate an upstream approach tailored to their setting.

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